Key Takeaways
- E/M levels should be validated using current MDM or qualifying time pathways.
- Modifier 25 and 59 require documentation-supported distinctness, not routine usage.
- Global package audits test whether separately billed services exceed included post-op care.
Last updated: February 2026
Avoiding common validation mistakes
- Do not validate E/M by diagnosis count alone.
- Do not accept modifier usage without note-level evidence.
- Do not treat payment success as proof of coding correctness.
Validation should be evidence-first and criteria-driven.
Test Your Knowledge
What is the strongest basis for accepting modifier 25 during audit?
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